scholarly journals Potential Impact of Choosing Wisely-- ED Coagulation Study (PT-PTT-INR): Utilization and Economic Modeling

2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Victoria McElroy ◽  
James Espinosa ◽  
Victor Scali ◽  
Henny Schuitema ◽  
Alan Lucerna
Keyword(s):  
Economic Modeling ◽  
Choosing Wisely ◽  
Coagulation Study ◽  
Potential Impact

scholarly journals LO27: Relevance of Choosing Wisely Canada non-emergency medicine specialty lists to emergency medicine practice

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S16-S17
Author(s):  
S. Upadhye ◽  
C. Davies-Schinkel ◽  
S. Pilakka
Keyword(s):  
Emergency Medicine ◽  
Quality Improvement ◽  
Patient Care ◽  
Resource Use ◽  
Emergency Departments ◽  
Rating Scale ◽  
Likert Scale ◽  
Choosing Wisely ◽  
Low Back ◽  
Potential Impact

Introduction: The Choosing Wisely Canada (CWC) initiative is dedicated towards optimizing patient care and reduce unnecessary resource use. Different specialty organizations create recommendations lists towards these outcomes. The goal of this study was to examine the applicability of non-Emergency Medicine (EM) recommendations towards EM practice. Methods: The entire master recommendations listings spreadsheet was downloaded from the CWC website (March 2019; n = 333). The EM-specific items from the CAEP checklist were deliberately excluded (n = 10). Items were rated by Niagara community EM physicians (n = 7) using the previously validated Best Evidence in Emergency Medicine (BEEM) rating scale (7 point Likert scale) to determine potential impact on EM practice. Items rated “6 or 7/7” were determine as “high relevance.” Redundant items were consolidated. Results: From the retrieved CWC master list, a total of 102 “highly relevant” recommendations were identified (41 items scored 6/7 [12%], 61 scored 7/7 [18%]; total 31%). Redundant items consolidated included antimicrobial avoidance (n = 18), opioid avoidance for pain (n = 11), reduction of unnecessary imaging (n = 11), and avoidance of routine low back imaging (n = 7). Conclusion: There are a large number of non-EM specialty recommendations highly relevant to EM practice in the CWC database (31%). Quality improvement initiatives looking to operational CWC recommendations in Canadian Emergency Departments should be aware of these as a part of optimizing patient care.

scholarly journals Choosing wisely in oncology: necessity and obstacles

ESMO Open ◽  
2018 ◽  
Vol 3 (5) ◽  
pp. e000382 ◽  
Author(s):  
Piercarlo Saletti ◽  
Piero Sanna ◽  
Luca Gabutti ◽  
Michele Ghielmini
Keyword(s):  
Diagnostic Procedures ◽  
Diagnostic Methods ◽  
Choosing Wisely ◽  
Medical Procedures ◽  
Patients With Cancer ◽  
Cancer Field ◽  
Potential Impact ◽  
Medical Disciplines

In the last decades, the survival of many patients with cancer improved thanks to modern diagnostic methods and progresses in therapy. Still for several tumours, especially when diagnosed at an advanced stage, the benefits of treatment in terms of increased survival or quality of life are at best modest when not marginal, and should be weighed against the potential discomfort caused by medical procedures. As in other specialties, in oncology as well the dialogue between doctor and patient should be encouraged about the potential overuse of diagnostic procedures or treatments. Several oncological societies produced recommendations similar to those proposed by other medical disciplines adhering to the Choosing Wisely (CW) campaign. In this review, we describe what was reported in the medical literature concerning adequacy of screening, diagnostic, treatment and follow-up procedures and the potential impact on them of the CW. We only marginally touch on the more complex topic of treatment appropriateness, for which several evaluation methods have been developed (including the European Society for Medical Oncology—magnitude of clinical benefit scale). Finally, we review the possible obstacles for the development of CW in the oncological setting and focus on the strategies which could allow CW to evolve in the cancer field, so as to enhance the therapeutic relationship between medical professionals and patients and promote more appropriate management.

THE POTENTIAL IMPACT OF CLIMATE CHANGE ON AGRICULTURE IN WEST AFRICA: A BIO-ECONOMIC MODELING APPROACH

2019 ◽  
Vol 10 (04) ◽  
pp. 1950015
Author(s):  
BORIS O. K. LOKONON ◽  
AKLESSO Y. G. EGBENDEWE ◽  
NAGA COULIBALY ◽  
CALVIN ATEWAMBA
Keyword(s):  
Climate Change ◽  
Land Use ◽  
Crop Production ◽  
Crop Yields ◽  
Negative Impact ◽  
Economic Modeling ◽  
Climate Conditions ◽  
Impact Of Climate Change ◽  
Potential Impact ◽  
The Impact

This paper investigates the impact of climate change on agriculture in the Economic Community of West African States (ECOWAS). To that end, a bio-economic model is built and calibrated on 2004 base year dataset and the potential impact is evaluated on land use and crop production under two representative concentration pathways coupled with three socio-economic scenarios. The findings suggest that land use change may depend on crop types and prevailing future conditions. As of crop production, the results show that paddy rice, oilseeds, sugarcane, cocoa, coffee, and sesame production could experience a decline under both moderate and harsh climate conditions in most cases. Also, doubling crop yields by 2050 could overall mitigate the negative impact of moderate climate change. The magnitude and the direction of the impacts may vary in space and time.

Effects of Gender, Parental Role, and Time on Infant- and Adult-Directed Read and Spontaneous Speech

2019 ◽  
Vol 62 (11) ◽  
pp. 4001-4014
Author(s):  
Melanie Weirich ◽  
Adrian Simpson
Keyword(s):  
Parental Involvement ◽  
Gender Identity ◽  
Spontaneous Speech ◽  
First Year ◽  
Space Size ◽  
Vowel Space ◽  
Potential Impact ◽  
Phonetic Features ◽  
And Gender ◽  
Description Task

Purpose The study sets out to investigate inter- and intraspeaker variation in German infant-directed speech (IDS) and considers the potential impact that the factors gender, parental involvement, and speech material (read vs. spontaneous speech) may have. In addition, we analyze data from 3 time points prior to and after the birth of the child to examine potential changes in the features of IDS and, particularly also, of adult-directed speech (ADS). Here, the gender identity of a speaker is considered as an additional factor. Method IDS and ADS data from 34 participants (15 mothers, 19 fathers) is gathered by means of a reading and a picture description task. For IDS, 2 recordings were made when the baby was approximately 6 and 9 months old, respectively. For ADS, an additional recording was made before the baby was born. Phonetic analyses comprise mean fundamental frequency (f0), variation in f0, the 1st 2 formants measured in /i: ɛ a u:/, and the vowel space size. Moreover, social and behavioral data were gathered regarding parental involvement and gender identity. Results German IDS is characterized by an increase in mean f0, a larger variation in f0, vowel- and formant-specific differences, and a larger acoustic vowel space. No effect of gender or parental involvement was found. Also, the phonetic features of IDS were found in both spontaneous and read speech. Regarding ADS, changes in vowel space size in some of the fathers and in mean f0 in mothers were found. Conclusion Phonetic features of German IDS are robust with respect to the factors gender, parental involvement, speech material (read vs. spontaneous speech), and time. Some phonetic features of ADS changed within the child's first year depending on gender and parental involvement/gender identity. Thus, further research on IDS needs to address also potential changes in ADS.

Exploring the Potential Impact of Sentence-Level Comprehension and Sentence-Level Fluency on Deaf Students' Passage Comprehension

2020 ◽  
Vol 63 (7) ◽  
pp. 2281-2292
Author(s):  
Ying Zhao ◽  
Xinchun Wu ◽  
Hongjun Chen ◽  
Peng Sun ◽  
Ruibo Xie ◽  
...  
Keyword(s):  
Independent Predictor ◽  
Vocabulary Knowledge ◽  
Group Differences ◽  
Regression Analyses ◽  
Deaf Students ◽  
Mediating Role ◽  
Sentence Level ◽  
Mediating Mechanisms ◽  
Potential Impact ◽  
The Relationship

Purpose This exploratory study aimed to investigate the potential impact of sentence-level comprehension and sentence-level fluency on passage comprehension of deaf students in elementary school. Method A total of 159 deaf students, 65 students ( M age = 13.46 years) in Grades 3 and 4 and 94 students ( M age = 14.95 years) in Grades 5 and 6, were assessed for nonverbal intelligence, vocabulary knowledge, sentence-level comprehension, sentence-level fluency, and passage comprehension. Group differences were examined using t tests, whereas the predictive and mediating mechanisms were examined using regression modeling. Results The regression analyses showed that the effect of sentence-level comprehension on passage comprehension was not significant, whereas sentence-level fluency was an independent predictor in Grades 3–4. Sentence-level comprehension and fluency contributed significant variance to passage comprehension in Grades 5–6. Sentence-level fluency fully mediated the influence of sentence-level comprehension on passage comprehension in Grades 3–4, playing a partial mediating role in Grades 5–6. Conclusions The relative contributions of sentence-level comprehension and fluency to deaf students' passage comprehension varied, and sentence-level fluency mediated the relationship between sentence-level comprehension and passage comprehension.

Klug entscheiden in der Rheumatologie

2016 ◽  
Vol 36 (06) ◽  
pp. 402-406 ◽  
Author(s):  
M. Lakomek ◽  
Ch. Specker ◽  
H.-J. Lakomek
Keyword(s):  
Rheumatoide Arthritis ◽  
Deutsche Gesellschaft ◽  
Choosing Wisely ◽  
Innere Medizin ◽  
Eine Hohe ◽  
Typ 2 Diabetes ◽  
International Medicine

ZusammenfassungIn Anlehnung an die amerikanische “Choosing wisely”-Initiative des American Board of International Medicine (ABIM-Foundation) aus dem Jahr 2012 hat die Deutsche Gesellschaft für Innere Medizin (DGIM) mit zwölf weiteren internistischen Schwerpunkt- bzw. assoziierten Fachgesellschaften und der AWMF im Jahr 2015 fachgebietsbezogene Gesundheitsbereiche mit einer Fehlversorgung identifiziert. Auch die Deutsche Gesellschaft für Rheumatologie hat hier jeweils fünf fachbezogene Aspekte der Unter- und Überversorgung beschrieben. Dies war Anlass für die Autoren, beispielhaft zu jeweils einer Positiv- (Unterversorgung) und einer Negativ-Empfehlung (Überversorgung) Stellung zu nehmen, um die Wichtigkeit der “Klug entscheiden”-Initiative für die akutstationäre Rheumatologie aufzuzeigen. Am Beispiel der Positiv-Empfehlung (+) “Das kardiovaskuläre Risikoprofil von Patienten mit entzündlich rheumatischen Erkrankungen soll bestimmt und ggfs. reduziert werden” wird für die rheumatoide Arthritis die Bedeutung der Beachtung dieser Komorbidität aufgezeigt. Zur Unterstützung einer hohen Behandlungsqualität ist die Diagnose einer Komorbidität wie die des metabolischen Syndroms und des Typ-2-Diabetes nicht nur für die Bewertung des kardiovaskulären Risikos von Menschen mit rheumatischen Erkrankungen äußerst wichtig, sondern es kann z. B. durch Veränderung des Lebensstils und die Auswahl bestimmter Immunsuppressiva auf die sich durch die Komorbidität ergebende Prognose, z. B. bei der rheumatoiden Arthritis, positiv Einfluss genommen werden. Am Beispiel der Negativ-Empfehlung (−) “Eine längerfristige Glukokortikoidtherapie mit einer Dosis von mehr als 5 mg/die Prednisonäquivalent soll nicht durchgeführt werden” – wird die Richtigkeit der vorgeschlagenen Zielsetzung mit dem ergänzenden Hinweis aufgezeigt, bei Absenkung einer längerfristigen Glukokortikoidtherapie auf das mögliche Vorliegen einer sekundären Nebennierenrindeninsuffizienz zu achten. Die Initiative “Klug entscheiden” auch in der Rheumatologie passt gut in den Kontext der aktuellen gesundheitspolitischen Aktivitäten, über die sektorale Patientenversorgung in Deutschland eine hohe Behandlungsqualität abzusichern.

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